PRA IC List
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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
Beneficiary Focus Groups
New
60
180
0
Other-Telephone Recruitment Script
Form and Instruction
CMS-10625
Core Focus Group Moderator’s Guide
Beneficiary Surveys
New
1400
350
0
Form
CMS-10635
Enrollee Beneficiary Survey (Screen Shots)
Form
CMS-10635
Disenrollee and Lockout Beneficiary Survey (Screen Shots)
Form
CMS-10635
Beneficiary Survey: Enrollees (paper)
Form
CMS-10635
Beneficiary Survey: Disenrollees (paper)
Form
CMS-10635
Beneficiary Survey: Enrollees (Spanish, paper)
Form
CMS-10635
Beneficiary Survey: Disenrollees (Spanish, paper)
Form
CMS-10635
Beneficiary Survey: Revised Enrollee/Disenrollees Race Question (screen shots)
Informational Interviews
New
25
38
0
Form and Instruction
CMS-10625
Interview Guide
Total burden requested under this ICR:
1485
568
0
To view an IC, click on IC Title
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